Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model

Journal of Sex Research,  August, 2004  by John Bancroft,  Zoran Vukadinovic

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High risk sexual behavior overlaps with but is not the same as out of control sexual behavior. However, on the basis of these findings, we formulated the following hypotheses as relevant to out of control sexual behavior:

1. A tendency to increased sexual interest and responsiveness during negative mood states will be more common in men with out of control sexual behavior.

2. Increased sexual interest associated with anxiety will be principally associated with out of control masturbation.

3. Increased sexual interest associated with depression will be associated with out of control interaction with sexual partners (e.g., increased number of sexual partners).

4. In general, out of control sexual behavior will be more likely in men with a combination of high SES and low SIS2, partly because of the paradoxical association between negative mood and sexuality and partly because of a more direct impact of high arousal and low inhibition on self-regulation.

In this project, we used a combination of interviews and questionnaires with a small sample of self-designated sex addicts to explore these theoretical possibilities, as well as other qualitative descriptions of the out of control sexual experience. We have also used an age-matched control group for evaluation of the questionnaire data.

METHODS

Participants

Following distribution of leaflets describing the research project to local Sex Addicts Anonymous (SAA) groups, 22 SAA members volunteered to be interviewed and complete questionnaires (20 male and 2 female). Interviews were recorded and transcribed. Each volunteer signed an informed consent sheet and was paid $35 for his or her participation. In addition, 11 self-defined sexual addiction patients (all male) attending The Kinsey Institute Sexual Health Clinic were assessed in a similar fashion. These patients were asked to sign an informed consent sheet and were charged only half of the usual clinic fee as compensation. We obtained approval for the study from the Indiana University Bloomington Human Subjects Committee.

To allow testing of our specific hypotheses with the questionnaire data from the male sample, we derived an age-matched sample from our two studies of mood and sexuality (Bancroft, Janssen, Strong, Carnes, et al., 2003a; Bancroft, Janssen, Strong, & Vukadinovic, 2003). First, we excluded those outside the age range of the sex addicts group (22-66). We then randomly selected a 50% sample from each orientation group. This produced the same mean age for the heterosexual men. The gay men were, however, younger, so we randomly deleted individual cases from the lower part of the age range until the same mean age was achieved. These two subsamples--heterosexual, n = 196, 57.8%, and homosexual, n = 143, 42.2%--were then combined (n = 339). (1)

Interviews

Issues covered in the research interviews included the type of behavior involved, the importance of novelty or specificity, the steps in a typical sequence, whether participants usually attempt to resist the urge to "act out," their state of mind while acting out, the extent to which the participants can exercise control over their behavior, how various mood states affect the acting out behavior, and the extent to which they use acting out to improve mood. We also asked questions about whether the individual had been sexually abused as a child, whether religion was important, whether there was evidence of other types of addictive behavior, and whether there was a family history of addictive disorders. Similar questions were asked of the clinic patients. Volunteer interviews were audiorecorded and transcribed. We then analyzed the content of the transcripts along with the case notes from the clinic patients to identify presence or absence of the key variables reported in this paper.